Provider Demographics
NPI:1891049243
Name:HOMETOWN PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:HOMETOWN PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:910-275-0195
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0009
Mailing Address - Country:US
Mailing Address - Phone:910-275-0195
Mailing Address - Fax:910-275-0192
Practice Address - Street 1:102 N MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-0001
Practice Address - Country:US
Practice Address - Phone:910-275-0195
Practice Address - Fax:910-275-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty